Applying the “Supportability” and “Consistency” Factors to Treating Nurse Practitioner Opinions: Commentary on Melody Olinger v. Commissioner of Social Security

I. Introduction

This commentary analyzes the Third Circuit’s nonprecedential opinion in Melody S. Olinger v. Commissioner of Social Security, No. 24‑3275 (3d Cir. Nov. 18, 2025), affirming the denial of Social Security disability benefits to claimant Melody S. Olinger.

Although expressly designated “NOT PRECEDENTIAL” under Third Circuit Internal Operating Procedure 5.7, the decision offers a detailed application of the post‑2017 Social Security regulations that govern how Administrative Law Judges (ALJs) must evaluate medical opinions—particularly the opinions of treating nurse practitioners (NPs)—under the “supportability” and “consistency” factors. It also illustrates how appellate courts review ALJs’ evaluation of subjective pain complaints under the “substantial evidence” standard.

The core disputes in the appeal were:

Whether the ALJ adequately articulated why two treating nurse practitioners’ opinions (NP Stephanie Deible from 2018, and NP Ann Sandor from 2022) were found “unpersuasive” under 20 C.F.R. § 404.1520c.
Whether the ALJ properly evaluated Olinger’s subjective complaints of disabling back pain after lumbar surgery, under 20 C.F.R. § 404.1529 and Third Circuit precedent.
Whether, in light of this evidence, the finding that Olinger retained the residual functional capacity (RFC) to perform a reduced range of light work was supported by substantial evidence.

This opinion, read together with Zaborowski v. Commissioner of Social Security, 115 F.4th 637 (3d Cir. 2024), illustrates how much explanation is required from ALJs in the Third Circuit when they discount a treating source’s opinion and prefer non‑treating, state agency opinions in modern Social Security disability adjudication.

II. Summary of the Opinion

Olinger applied for disability benefits in 2020, alleging disability as of August 2018 due to PTSD, anxiety, and sciatica. She subsequently developed significant back problems leading to a lumbar laminectomy in March 2020.

At her administrative hearing, Olinger relied primarily on:

NP Stephanie Deible (2018) – who opined that Olinger could not sit, stand, or walk for more than one hour per day and would have significant pain episodes.
NP Ann Sandor (2022) – who opined that Olinger’s conditions would frequently interfere with work and cause her to miss more than two days per month.

The ALJ:

Found severe impairments including intervertebral disc disorders with radiculopathy, lumbar spinal stenosis, post‑laminectomy syndrome, PTSD, depression, and generalized anxiety disorder.
Nevertheless concluded that Olinger retained the RFC to perform a reduced range of light work and that there were other jobs in the national economy she could perform, even though she could no longer work as a store clerk.
Found the opinions of both treating NPs unpersuasive due to lack of supportability and inconsistency with objective medical evidence, treatment history, other clinicians’ findings, and Olinger’s daily activities.

The District Court (W.D. Pa., Judge Alan Bloch) affirmed, holding that the ALJ’s evaluation of the medical opinions and Olinger’s subjective complaints was supported by substantial evidence and that the ALJ applied the correct legal standards.

On appeal, the Third Circuit:

Reviewed the District Court’s decision de novo but applied the substantial evidence standard to the ALJ’s factual findings.
Rejected each of Olinger’s three challenges: (1) alleged failure to properly explain the rejection of NP Deible’s opinion; (2) alleged failure to properly explain the rejection of NP Sandor’s opinion; and (3) alleged failure to support the RFC finding concerning the persistence and intensity of her back pain.
Concluded that the ALJ’s decision satisfied the regulatory requirements to articulate supportability and consistency and that the record contained “substantial evidence” to support the ALJ’s RFC and non‑disability determination.

The court therefore affirmed the District Court’s judgment upholding the Commissioner’s denial of benefits.

III. Detailed Analysis

A. Procedural Posture and Standard of Review

The opinion begins by confirming the familiar framework for judicial review of Social Security decisions:

The District Court reviewed the ALJ’s decision on cross‑motions for summary judgment and upheld the Commissioner.
The Third Circuit reviewed the District Court’s judgment de novo but would reverse the Commissioner only if the ALJ’s factual findings were not supported by substantial evidence (citing Boone v. Barnhart, 353 F.3d 203, 205 (3d Cir. 2003), and Burns v. Barnhart, 312 F.3d 113, 118 (3d Cir. 2002)).

The court then reiterated the definition of “substantial evidence” from Biestek v. Berryhill, 587 U.S. 97 (2019), and Consolidated Edison Co. v. NLRB, 305 U.S. 197 (1938):

“Substantial evidence is more than a mere scintilla. It means such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.”

This high‑level standard heavily constrains appellate review: if the ALJ’s decision can reasonably be supported on the present record—even if other evidence would support a contrary finding—the court must affirm. That backdrop is critical to understanding why Olinger’s arguments failed.

B. Treatment of Medical Opinion Evidence: Supportability and Consistency

Because Olinger’s claim was filed in 2020, it is governed by the post‑March 27, 2017 Social Security regulations that dramatically changed how medical opinions are evaluated, particularly 20 C.F.R. § 404.1520c. Under these rules:

No medical source, including a treating physician or nurse practitioner, is entitled to “controlling weight.”
The ALJ instead assesses the persuasiveness of each medical opinion.
The two most important factors are:
- Supportability – whether the opinion is backed by objective medical evidence and explanations.
- Consistency – whether the opinion aligns with other medical and non‑medical evidence in the record.
ALJs must articulate how they considered supportability and consistency for each medical opinion. 20 C.F.R. § 404.1520c(b)(2).

The Third Circuit recently interpreted these requirements in Zaborowski v. Commissioner of Social Security, 115 F.4th 637 (3d Cir. 2024), which this panel cites to define supportability and consistency. The Olinger opinion can be seen as an application of Zaborowski to the facts of a case involving treating nurse practitioners whose opinions were more restrictive than those of other clinicians and state agency consultants.

1. NP Stephanie Deible’s 2018 Opinion

NP Deible treated Olinger in August 2018 following a workplace chemical exposure when Olinger was working as a store clerk. Deible opined that Olinger could not sit, stand, or walk for more than one hour per day and would experience debilitating pain episodes multiple times per week. Olinger argued on appeal that the ALJ failed to adequately address:

The supportability of Deible’s limitations (especially the one‑hour sitting/standing/walking restriction), and
The consistency of Deible’s opinion with the rest of the record.

The Third Circuit disagreed, emphasizing three aspects of the ALJ’s reasoning:

Temporal Staleness Relative to Back Injury
The ALJ noted that Deible’s opinion was given in 2018, more than a year before Olinger began complaining of the back pain that led to her March 2020 laminectomy. The court accepted the ALJ’s view that:
- Deible’s opinion arose from a distinct incident (chemical exposure) and predates the onset of the alleged disabling back condition.
- As such, it was “stale” when compared with later evidence, including more recent examinations and other clinicians’ findings.
Lack of Supportability in Objective Findings
The ALJ found that Deible’s severe restrictions were “not fully supported by the clinical signs and findings,” citing examinations in February 2021 showing:
- No distress,
- Normal gait,
- No muscle spasms,
- No pain with palpation of the lumbar spine.
Later examinations from April to December 2021 similarly showed that Olinger was alert, oriented, and had a normal mood and affect. The court held that this satisfied the supportability requirement: the ALJ grounded her assessment in specific objective findings that conflicted with Deible’s extreme limitations.
Inconsistency with Daily Activities and Other Medical Opinions
The ALJ further concluded that Deible’s opinion was “inconsistent with the claimant’s activities of daily living,” where Olinger:
- Prepared meals,
- Performed household chores,
- Drove,
- Went grocery shopping,
- Attended appointments.
The ALJ also found inconsistency with:
- The “effectiveness of treatment,”
- State agency psychological consultants’ findings,
- A consultative examiner’s opinion.
In contrast, a state agency medical consultant concluded that Olinger could perform light exertional work with only limited restrictions (e.g., occasional pushing/pulling with the left lower extremity, frequent climbing, stooping, and crouching), and a primary care physician reported “no restrictions” in basic functional activities like kneeling, standing, sitting, and walking.

In line with Zaborowski, the court held that the ALJ adequately articulated why Deible’s opinion was both poorly supported and inconsistent, and thus unpersuasive, and that substantial evidence supported this conclusion.

2. NP Ann Sandor’s 2022 Opinion

NP Sandor saw Olinger in 2022 and opined that Olinger’s conditions would:

Frequently interfere with her ability to stay on task at work; and
Cause her to miss more than two days of work per month.

On appeal, Olinger argued that:

The ALJ did not properly address the supportability of Sandor’s opinion; and
Any discussion of consistency was inadequate.

The Third Circuit again sided with the ALJ, emphasizing:

Supportability: Objective Findings and Sandor’s Own Notes
The ALJ found that Sandor’s predictive limitations (frequent off‑task behavior and excessive absenteeism) were “not fully supported” by objective findings, including:
- Exams from April–September 2021 showing only mild tenderness, mildly limited range of motion in the lumbar spine, full lower extremity muscle strength, normal reflexes, and no neurologic deficits.
- A February 2022 evaluation (by Sandor herself) noting:
  - Stable pain,
  - Only mild left lower extremity weakness,
  - No limp,
  - No neurologic deficits.
By pointing to these specific, relatively benign findings, the ALJ concluded that the dramatic work‑related limitations Sandor proposed were inadequately supported by her own clinical observations and the broader record.
Consistency: Alignment with Other Medical Sources and Treatment History
The ALJ also found Sandor’s opinion inconsistent with:
- State agency medical consultants’ findings that Olinger could perform a range of light work;
- Olinger’s medical treatment history, including:
  - Reports that medication management provided “adequate pain relief and decreased muscle cramping” from April–September 2021;
  - Reports in December 2021 that steroid injections provided pain relief and her pain was “stable;”
  - Reports in February 2022 of stable symptoms and only mild weakness, no limp, and no neurologic deficits.
The ALJ used this treatment history to show that Olinger’s pain—while real—was reasonably controlled and stable, in tension with Sandor’s forecast of frequent off‑task behavior and absences.

The Third Circuit concluded that this articulation met the regulatory requirements; the ALJ identified both concrete objective findings (supportability) and conflicting opinions and treatment outcomes (consistency) to justify discounting Sandor’s opinion.

C. Evaluation of Subjective Pain Complaints and RFC for Light Work

Beyond the medical opinion evidence, Olinger argued that the ALJ erred in concluding that she was capable of a range of light work in light of her ongoing back pain following lumbar surgery. She asserted that:

The ALJ failed to identify genuine inconsistencies between her testimony and the record; and
The ALJ did not adequately reconcile the rejection of her allegations with record evidence consistent with her testimony about limited ability to sit or stand.

The Third Circuit applied the standard from Hartranft v. Apfel, 181 F.3d 358 (3d Cir. 1999):

Once an ALJ concludes that a medical impairment that could reasonably cause the alleged symptoms exists, he or she must evaluate the intensity and persistence of the pain or symptom, and the extent to which it affects the individual's ability to work.

The key question is whether the ALJ reasonably explained why Olinger’s pain, though acknowledged, did not preclude light work. The court pointed to several elements of the ALJ’s analysis:

Evidence of Post‑Surgical Improvement
The ALJ relied on:
- Multiple clinicians’ post‑surgery observations that Olinger showed “significant improvement in her symptoms.”
- The orthopedic surgeon’s clearance for lifting under twenty‑five pounds.
- A pain management specialist’s finding of only mild tenderness, full muscle strength, and normal reflexes.
- Clinicians’ overall conclusions that Olinger could perform various motor activities.
These findings, in the court’s view, constituted substantial evidence that, while Olinger still had limitations, her impairment was not disabling.
Claimant’s Own Reports of Pain Relief and Stability
The ALJ highlighted that Olinger herself:
- Reported that pain and medication management provided “adequate pain relief and decreased muscle cramping” during 2021,
- Described her pain as “stable” after steroid injections in December 2021, and
- In February 2022, reported stable symptoms with only mild weakness, no limp, and no neurological deficits.
These self‑reports undercut the narrative of unremitting, disabling pain that would preclude sustained light work.
Functional Observations and Activities
The ALJ considered functional evidence:
- Olinger testified she could walk a quarter mile, stand six to eight minutes, and sit 15 minutes.
- In a December 2021 exam, she could ambulate without an assistive device and “sat comfortably.”
- She engaged in activities such as laundry, cleaning, shopping, driving, and meal preparation.
While these activities do not automatically negate disability, the ALJ used them to show inconsistency between total disability and Olinger’s actual functioning.
Reliance on State Agency and Other Medical Opinions
The ALJ gave weight to:
- The orthopedic surgeon’s opinion that she could lift less than twenty‑five pounds, and
- The state agency medical consultant’s opinion that she could perform a range of light work.
These supported an RFC consistent with light exertional work (with some restrictions), rather than the much more limited picture painted by Olinger’s testimony and the treating NPs’ opinions.

The Third Circuit emphasized that the ALJ “exhaustively evaluated the intensity and persistence” of Olinger’s back pain before concluding that she could engage in a reduced range of light work. The fact that the ALJ did not fully credit her subjective complaints did not amount to error; it reflected a permissible weighing of conflicting evidence.

D. Precedents Cited and Their Influence

1. Boone v. Barnhart and Burns v. Barnhart – Appellate Review Framework

Boone and Burns are cited for the settled proposition that:

The Court of Appeals reviews the District Court’s grant of summary judgment de novo; but
It defers to the ALJ’s underlying factual findings as long as they are supported by substantial evidence.

These cases reinforce the deferential nature of Social Security review: appellate courts do not re‑weigh evidence or make independent disability determinations.

2. Biestek v. Berryhill and Consolidated Edison Co. v. NLRB – Defining “Substantial Evidence”

The opinion quotes Biestek and Consolidated Edison to define “substantial evidence” as:

“such relevant evidence as a reasonable mind might accept as adequate to support a conclusion.”

By invoking these cases, the court reminds that:

The substantial evidence standard is not demanding.
An ALJ’s conclusion can be upheld even where the record could support a different outcome, so long as the decision has a reasonable evidentiary basis.

3. Zaborowski v. Commissioner of Social Security – Interpreting § 404.1520c

Zaborowski is pivotal in understanding this opinion. It clarified:

What “supportability” and “consistency” mean under 20 C.F.R. § 404.1520c(c); and
What level of articulation is required of ALJs when evaluating medical opinions under the new regulations.

The panel quotes Zaborowski to define:

Supportability: whether the opinion is grounded in “objective medical evidence and supporting explanations.”
Consistency: whether it is consistent “with other medical opinions in the record.”

In Olinger, the court applies Zaborowski to uphold an ALJ who:

Expressly discussed the objective findings that undercut the NPs’ opinions (supportability); and
Compared those opinions to state agency consultants, consultative examiners, treatment success, and daily activities (consistency).

The opinion, therefore, reinforces that detailed—though not elaborate—references to objective findings and conflicting medical opinions suffice under Third Circuit law.

4. Hartranft v. Apfel – Evaluation of Subjective Symptoms

Hartranft is cited for the principle that, once the ALJ acknowledges a medically determinable impairment that could reasonably cause alleged symptoms, the ALJ must then:

Assess the intensity and persistence of those symptoms; and
Determine how they limit the claimant’s ability to work.

Olinger applies this framework by:

Accepting that Olinger’s lumbar issues could cause pain; but
Affirming the ALJ’s conclusion that, in light of improvement, treatment response, and clinical findings, the pain did not preclude light work.

This underscores that credible pain complaints can still be found insufficient to support disability where objective evidence and treatment outcomes show significant functional capacity.

E. Legal Reasoning: Why the Court Affirmed

The Third Circuit’s reasoning can be distilled into several overarching points:

The ALJ Adequately Addressed Supportability and Consistency
For both NPs, the ALJ:
- Identified specific objective findings (e.g., normal gait, full strength, mild tenderness, normal reflexes) that did not support the extreme limitations offered.
- Contrasted those opinions with:
  - Other clinicians’ less restrictive assessments,
  - State agency consultants’ RFC for light work,
  - Favorable response to treatment and pain stability, and
  - Claimant’s daily activities and observed functional abilities.
This satisfied § 404.1520c and Zaborowski. The court rejected the notion that the ALJ had to separately and exhaustively dissect each specific limitation (e.g., sitting for only one hour) if the broader reasoning adequately explained why the opinion as a whole was unpersuasive.
Staleness and Temporal Relevance of Opinions
The ALJ considered that Deible’s opinion predated the onset of documented back pain and the subsequent surgery, making it less probative of Olinger’s functioning during the relevant period. This “staleness” concept is consistent with the idea that medical opinions must be evaluated in the context of the entire longitudinal record.
Objective Evidence vs. Subjective Complaints
The ALJ acknowledged Olinger’s pain testimony but weighed it against:
- Consistent post‑surgical improvements,
- Benign objective findings, and
- Functionally significant daily activities.
Under Hartranft and § 404.1529(c)(4), this comparative analysis is not just permitted—it is required.
Deference Under Substantial Evidence Standard
The court emphasized that the role of substantial evidence review is not to choose between competing plausible interpretations. Because the ALJ’s conclusions were reasonably supported by the record—including multiple clinicians’ observations and Olinger’s own reports of improvement—the court was bound to affirm—even if a different factfinder might have been more persuaded by the treating NPs.

F. Impact and Future Implications

Although designated as nonprecedential, this decision is still instructive within the Third Circuit and beyond, particularly in the following respects:

1. Confirmation of a Relatively Modest Articulation Requirement

Olinger shows that ALJs do not need to write lengthy, treatise‑style discussions of each medical opinion. What is required is:

Identification of specific objective evidence that supports or undermines a medical opinion (supportability); and
Identification of key conflicts with other opinions, treatment history, and activities (consistency).

This opinion confirms that brief but specific references to clinical findings and record inconsistencies suffice.

2. Treatment of Nurse Practitioner Opinions in the Post‑2017 Regulatory Era

Under current regulations, nurse practitioners—like physicians—have their opinions evaluated for persuasiveness under the same supportability/consistency framework. Olinger makes clear that:

There is no automatic preference for treating NP opinions simply because they come from ongoing treating relationships.
ALJs may properly favor state agency medical consultants and other clinicians where the treating NP’s opinion is:
- Not well‑supported by objective observations or
- Inconsistent with the broader record and treatment outcomes.

Practitioners should therefore ensure that treating source opinions, especially from NPs, are tightly linked to objective findings and harmonized with the full treatment record to maximize their persuasive value.

3. Use of “Stale” Opinions

The decision reinforces the doctrine that older medical opinions—especially those predating significant changes in a claimant’s condition—can be discounted as “stale.” For claimants:

It is important to obtain updated functional assessments that reflect the current level of impairment.
Reliance on early, pre‑surgery opinions is risky if later records show improvement.

4. Pain, Improvement, and Treatment Response

The court’s emphasis on Olinger’s “favorable response to treatment” and “stable” pain illustrates a broader principle:

Evidence that a claimant’s symptoms are managed or stabilized with treatment can significantly undermine allegations of complete disability, even in the presence of severe impairments.
Claimants who report improvement and adequate pain control must be prepared to explain why, despite that improvement, they still cannot sustain full‑time work.

5. Practical Lessons for ALJs and Advocates

For ALJs:

Document specific evidence when rejecting or discounting a treating opinion, especially from NPs.
Cross‑reference functional claims with daily activities, treatment success, and clinical findings.

For claimant’s counsel:

Challenge ALJ decisions by identifying specific failures in discussing supportability/consistency, not merely by arguing that the ALJ did not adopt your preferred medical opinion.
Where possible, provide longitudinal treating records that consistently document limitations and explain apparent improvements or “good days” in the context of a fluctuating condition.

IV. Complex Concepts Simplified

The following brief explanations may help non‑specialists understand the legal concepts referenced in the opinion:

Substantial Evidence
A legal standard for judicial review of agency decisions. It does not mean “beyond a reasonable doubt” or even “more likely than not.” Instead, it asks whether there is enough relevant evidence that a reasonable person could agree with the agency’s decision, even if another person might disagree.
Residual Functional Capacity (RFC)
An assessment of what a claimant can still do, physically and mentally, on a sustained basis (8 hours a day, 5 days a week), despite their impairments. Here, the ALJ found that Olinger could do a “reduced range of light work.”
Light Work
A category of work defined by Social Security rules that generally involves:
- Lifting no more than 20 pounds at a time,
- Frequently lifting or carrying objects up to 10 pounds,
- A good deal of walking or standing, or
- Sitting most of the time with some pushing and pulling of arm or leg controls.
The ALJ concluded that, with some limitations, Olinger could perform this level of work.
Supportability (of a medical opinion)
Refers to how well a medical opinion is backed up by the doctor’s or NP’s own clinical notes, test results, and explanations. An opinion with no or weak objective backing is considered less “supportable.”
Consistency (of a medical opinion)
Refers to how well a medical opinion fits with the entire record, including other doctors’ opinions, test results, treatment history, and the claimant’s daily activities. If an opinion is out of step with everything else, it is considered less “consistent.”
Nonprecedential Opinion
A decision that, under a court’s internal rules, is not binding in future cases. It can still be cited and considered persuasive, but judges are not required to follow it the way they must follow binding precedent.

V. Conclusion

Melody Olinger v. Commissioner of Social Security exemplifies the modern Third Circuit approach to Social Security disability appeals under the post‑2017 regulatory framework. While nonprecedential, the opinion:

Reinforces that ALJs must explicitly address supportability and consistency when evaluating medical opinions, including those of treating nurse practitioners, but that concise explanations anchored in the record are sufficient.
Confirms that treating NP opinions can be deemphasized when they are temporally stale, clinically unsupported, or inconsistent with other opinions and evidence.
Demonstrates deference to ALJ findings on subjective pain and RFC when post‑surgical improvement, stable symptoms, and normal or near‑normal objective findings are documented.

In the broader legal landscape, Olinger operates as a practical illustration of how the Third Circuit applies Zaborowski and related authorities, and it signals to ALJs and practitioners the level of explanation and record development necessary to withstand substantial evidence review in disability cases involving conflicting medical opinions and subjective pain complaints.